Many body conduits are generally cylindrical in configuration and have a generally circular cross-section. The surgical attachment of one body conduit to another is commonly referred to as an anastomosis. The complexity of anastomosis attachment is made apparent in a surgical procedure referred to generally as a radical prostatectomy, which is a well-established surgical procedure, typically for patients with localized prostatic carcinoma.
In a radical prostatectomy, the surgeon removes all or most of the patient's prostate. Because the urethra travels through the prostate immediately before reaching the bladder, a portion of the upper part of the urethra is removed in the surgery. In order to restore proper urinary functions, the bladder neck and the urethral stump must be reconnected.
Typically, radical prostatectomy procedures require the removal of cancerous tissue while preserving sexual function and continence in the patient. There are two common types of radical prostatectomy approaches for the removal of prostate cancer, the retropubic approach and the perineal approach. In either procedure, the removal of the prostate gland results in the creation of a bladder neck and urethral stump which are attached together in an anastomosis procedure. Typically, the urethral opening at the end of the bladder neck is closed sufficiently (e.g., by stitching) so that its size approximates the size of the urethral opening at the end of the urethral stump. The bladder neck is then positioned against the urethral stump and the two are stitched together to create a new, shortened conduit (urethra) extending from the bladder to the external urethral opening (i.e., the urethral exit at the end of the penis, or meatus).
In each of the above described procedures, it is the attachment of the urethral stump to the bladder neck which is particularly difficult and complex. This difficulty is complicated by the tendency of the urethral stump to retract into adjacent tissue. As a result, considerable time and effort can be expended to re-expose the urethral stump and begin the re-anastomosis procedure. Further complicating this procedure is the fact that the urethral stump is positioned beneath the pubic bone thus requiring that the surgeon work at a difficult angle and in positions that are uncomfortable and limiting.